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High Prevalence of Carriage of Methicillin-Resistant Staphylococcus aureus at Hospital Admission in Elderly Patients: Implications for Infection Control Strategies

Published online by Cambridge University Press:  21 June 2016

Jean-Christophe Lucet ,
Karine Grenet ,
Laurence Armand-Lefevre ,
Marion Harnal ,
Elisabeth Bouvet ,
Bernard Regnier  and
Antoine Andremont
Jean-Christophe Lucet*
Affiliation:
Infection Control Unit, Bichat-Claude Bernard Teaching Hospital, Assistance publique - hôpitaux de Paris, Paris, France
Karine Grenet
Affiliation:
Bacteriology Laboratory, Bichat-Claude Bernard Teaching Hospital, Assistance publique - hôpitaux de Paris, Paris, France
Laurence Armand-Lefevre
Affiliation:
Bacteriology Laboratory, Bichat-Claude Bernard Teaching Hospital, Assistance publique - hôpitaux de Paris, Paris, France
Marion Harnal
Affiliation:
Infection Control Unit, Bichat-Claude Bernard Teaching Hospital, Assistance publique - hôpitaux de Paris, Paris, France
Elisabeth Bouvet
Affiliation:
Infection Control Committee, Bichat-Claude Bernard Teaching Hospital, Assistance publique - hôpitaux de Paris, Paris, France
Bernard Regnier
Affiliation:
Medical Intensive Care Unit, Bichat-Claude Bernard Teaching Hospital, Assistance publique - hôpitaux de Paris, Paris, France
Antoine Andremont
Affiliation:
Bacteriology Laboratory, Bichat-Claude Bernard Teaching Hospital, Assistance publique - hôpitaux de Paris, Paris, France
*
Unité d'Hygiène et de Lutte contre l'Infection Nosocomiale, GH Bichat-Claude Bernard, 75877 Paris Cedex 18, France. jean-christophe.lucet@bch.ap-hop-paris.fr
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Abstract

Background:

Despite contact isolation precautions for patients with methicillin-resistant Staphylococcus aureus (MRSA), MRSA infections are increasing in many countries.

Objective:

To evaluate the role of a potential unrecognized reservoir of MRSA carried by patients in acute care wards, we determined the prevalence of MRSA at hospital admission, with special emphasis on screening-specimen yields.

Setting:

A 1,100-bed teaching hospital in Paris, France.

Methods:

Nasal screening cultures were performed at admission to a tertiary-care teaching hospital for patients older than 75 years.

Results:

MRSA was isolated from 63 (7.9%) of 797 patients. On the multivariate analysis, variables significantly associated with MRSA carriage were presence of chronic skin lesions (adjusted odds ratio [AOR], 5.10; 95% confidence interval [CI95], 2.52–10.33); transfer from a nursing home, rehabilitation unit, or long-term-care unit (AOR, 4.52; CI95, 2.23–9.18); and poor chronic health status (AOR, 1.80; CI95, 1.02–3.18). Without admission screening, 84.1% of MRSA carriers would have been missed at hospital admission and 76.2% during their hospital stay. Furthermore, 81.1% of days at risk for MRSA dissemination would have been spent without contact isolation precautions had admission screening not been performed.

Conclusions:

MRSA carriage at hospital admission is far more prevalent than MRSA-positive clinical specimens. This may contribute to failure of contact isolation programs. Screening cultures at admission help to identify the reservoir of unknown MRSA patients.

Information

Type
Original Articles
Information
Infection Control & Hospital Epidemiology , Volume 26 , Issue 2 , February 2005 , pp. 121 - 126
Copyright
Copyright © The Society for Healthcare Epidemiology of America 2005

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